Background From individual randomized studies it is unclear which of patellar (PT) tendon or hamstring (HS) tendon grafts yields the best functional results after ACL reconstruction. Therefore, we performed a meta-analysis to provide quantitative data to compare PT (control group) to HS (treatment group) grafts after ACL reconstruction with regards to knee function.

Methods We searched computerized databases for randomized controlled trials reporting one of the following outcome related to function: final overall International Knee Documentation Committee (IKDC) score and return to pre-injury level of activity. Studies were abstracted independently by two reviewers. Random effect models were used to pool the data.

Results Fourteen trials (1263 patients) met the inclusion criteria. There was no difference in final overall IKDC and in the number of patients returning to full activity after PT and HS graft reconstruction. Relative risk was 0.90 for final overall IKDC score class A in favor of PT grafts (not significant, P=0.13), and 0.94 for return to pre-injury level of activity in favor of PT grafts (not significant, P=0.28). Quantitative interaction tests on the effect of treatment based on study quality, randomization status, number of strands used, and length of follow-up were not significant. At last follow-up, only 41% and 33% of PT and HS graft reconstructed patients were respectively reported as normal using the final overall IKDC.

Conclusion There was no difference in the final overall IKDC and in the number of patients returning to full activity after HS tendon graft and PT graft reconstructions. It should be emphasized that more than 60% of the patients will not make full recovery after their reconstruction and patients should be informed accordingly.